title: Procedural sedation and analgesia in rural and regional emergency departments.
abstract: BACKGROUND
  Several agents can be administered during procedural sedation and analgesia (PSA) in the emergency department (ED). The purpose of this study was to determine the PSA agents commonly used by physicians working in nontertiary EDs, and to assess the physicians' comfort level administering the agents as well as their knowledge of adverse effects of the agents.
  
  
  METHODS
  We distributed a confidential electronic survey to physicians working in nontertiary EDs in southwestern Ontario. Using a 5-point Likert scale, ED physicians were asked to rate their use of older and newer agents used for PSA in the ED, as well as their familiarity with the agents.
  
  
  RESULTS
  A total of 55 physicians completed the survey. The most frequently used drugs were fentanyl (66.0% often or always) and propofol with fentanyl (59.2% often or always). Most respondents stated that they rarely used ketofol (54.2% rarely or never) or etomidate (77.1% rarely or never). Respondents were most comfortable using midazolam or fentanyl (96.1% somewhat or very comfortable), and least comfortable administering etomidate and ketofol (36.5% and 23.1% somewhat or very uncomfortable). These differences were magnified with comparison of physicians with CCFP (Certification in The College of Family Physicians) and CCFP(EM) (emergency medicine) designations. Additionally, etomidate's adverse effects were the least astutely recognized (19%), compared with midazolam combined with fentanyl (63%).
  
  
  CONCLUSIONS
  Physicians practising in nontertiary EDs used more often, remained more comfortable with and were more familiar with older sedation agents than newer agents.
authors.affiliation: Schulich School of Medicine & Dentistry, Western University, London, Ont.
authors.forename: Rovina Fiona
authors.initials: RF
authors.lastname: Pinto
authors.forename: Munsif
authors.initials: M
authors.lastname: Bhimani
authors.forename: William Ken
authors.initials: WK
authors.lastname: Milne
authors.forename: Kathryn
authors.initials: K
authors.lastname: Nicholson
mesh_terms: D000328:Adult; D000698:Analgesia / Q000706:statistics & numerical data*; D000700:Analgesics / Q000627:therapeutic use*; D016292:Procedural Sedation / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D009864:Ontario; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012424:Rural Population; D011795:Surveys and Questionnaires
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives